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APPLICATION FOR SANITATION PERMIT Permit' No. (Complete in Duplicate) -Date Issued e y Applica-lion is hereby ma cle to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i. JOB ADDRESS AND�l ION_:___--- A Z 44 01----------------- ------------------------------------ 00 P1. ---------------------------- -------------------------------------- Phol Owner's Name--------- ------- Address........--------1 F 1q, - -------- Contractor's Name------f 7---I- - Z----------------------- -------------- -- -- --- ---------- --------------------------- ------------------- ------------ g!7 Installation will serve: Residence d Apartment House E] Comme c a, rai er (;PurlP Motel ❑ Other ❑ units: Number of bedrooms Number of:size ------ Water"Supply. Public system 2___C1mmunify`system [_1 Private E] Depth to Water Table $7� ft.-- Character of soil to"a depth of 3 fee.f: 'Sand Gravel L] Sandy Loam [I Clay Loam E]Clay Adobe 2""Harcipan E] Previous Application Made: Yes El No ;� New'Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool ' iffed if public sewer is available within n m 200 feet.) Septic Tank: Disiance from neare5f weft________________Distance from foundation__-_._____._.___.__ No: of compartments_--------------------- Size Material:----------------------------------------------------------------------------.__Uquicl"clep�h--------------- - --------C�Ipacit -- y_-------------------- Dispos',/?I?i,y-:"'�'Distaince from nearest well__----------...'Distance from foundat;on-------------------- Distance to nearest lot line r V El Number of lines------------------------------------Length of each line------------------------------Width of french.-- rfilter., ---------------------------- -Type or ' -m' aterial-------------------------Depth of filter-material.----------------------Total length------------------ i to nearest-well---------—--------Distance from faun 'ation------ bi—stppce t-ol nearest Iot__1,i_n__e Seepage Pit: isfan7_ ' 7 Number of p;fs------- :-------Lining maferial_-��----- -------- Size: Diame ---------------- I ter----- Depth--- .__a----------I--------- Cesspool: t Distance from nearest well-_______________ Distance from-foundation.___.__-____._F----Lining material_._.__._.____.._-___._ \ �1`� ❑ Size: aterial-------------- ------------- Size: Diameter------- --------------------------------Depth-------------------- i ----------------i---------------Liquid Capacity--------------------------gals. Privy: Distance tance from.nearest well____________________________----------------------------------------Distance from nearest building --------------------------- El Distance to nearest lot line ------------- 104— -------------------------------------- Remodeling and/or repairing (do scribe): ------------ ------ -----------I------------------------------------------------------------------------------------------------------------------------------:----------- --- --- ----------:---------------------------------------------------------- ----------------------------------------------------I---------------------------I--------------------------------------------- --------------------- ------------------------- ------------I-------------------------------------------------------------------------------------------------------------I—--------------------------------------- I hereby certify that I have prepared this application and that the work will be done inaccordancewith San Joaquin County ordinances. State laws.--and-rules and regulations of the San Joaquin Local Health District. d]------- --- - ---- --------- -- (Signe -------- --------- and/or Contractor) By:------- - --------- ------------------------- -------------------------------------(Title)----(Plot ---------- plan. showing size'of lot, locatio6 of system in relation to wells, buildings, etc., can be' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.----; --'----'-------------'-------'-----i -------------- DATE--- --------- --- 0_7------- REVIEWED BY BUILDING PERMIT ISSUED______ ---------------------------------------------- DATE----------------------------------------------------------- ----------------------------------------------------------------------------------- DATE------- Alterations and/or recommendations:............ ---------------------------------------------- - ------ -------------m----------------------------f---------1--------L---------------------,-------------"------I•---------- ------------ .. ------------------------------------------------------------------------------------------------------------------------------------------------I------------------------- A - ------------------------------------------ -----------------------------------I------------------------------------------------------------------------------- I --------------------------------------------------------I---------------L------i--------------------- ----------- -----------7--------------- ------ ------------------------------------------------------------------------------------------------------------------------ ---------------------------------------I------------1*-------- ----------- -------------------------------------------------------------------- ---------------------------- ----------------- --------------------------- tj ! ---------------------- -------------------------------------- FINAL INSPECTION Da BY:--- te-_-------------------- ------------------------------------------------------ ------- -------------- ----• ..gate JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C', Street Stockton, California Lodi, California Manteca, California Tracy. California fl, ES-9-2M Revised W-2100